Hospital inpatient & observation

99221 - RVUs & Medicare payment (2026)

Initial hospital or observation visit, level 1.

Component	Non-facility	Facility
Work RVU	1.63	1.63
Practice expense RVU	0.41	0.41
Malpractice RVU	0.19	0.19
Total RVUs	2.23	2.23
National payment (CF $33.4009)	$74.48	$74.48
Qualifying APM payment (CF $33.5675)	$74.86	$74.86

How 99221 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99221 ranges from $69.48 in Arkansas (AR) to $99.75 in Alaska (AK); calculate 99221 for your locality.

Alaska (AK) $99.75 NYC Suburbs/Long Island (NY) $86.00 Miami (FL) $84.75 Manhattan (NY) $83.91 San Jose-Sunnyvale-Santa Clara (CA) $83.58 Queens (NY) $83.27 Chicago (IL) $83.15 San Jose-Sunnyvale-Santa Clara (CA) $82.70 National average $74.48 … 97 more localities between … Wisconsin (WI) $69.52 Iowa (IA) $69.49 Nebraska (NE) $69.48 Arkansas (AR) $69.48

Non-facility payment for 99221 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - hospital inpatient & observation

99222 · initial hospital or observation visit, level 2
99223 · initial hospital or observation visit, level 3
99231 · subsequent hospital or observation visit, level 1
99232 · subsequent hospital or observation visit, level 2
99233 · subsequent hospital or observation visit, level 3
99238 · hospital discharge management, 30 minutes or less
99239 · hospital discharge management, more than 30 minutes

Frequently asked questions

How much does Medicare pay for 99221 in 2026?

The national non-facility payment is $74.48 and the facility payment is $74.48, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 99221?

The 2026 work RVU for 99221 is 1.63. Total RVUs are 2.23 in the non-facility setting and 2.23 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.